1700108636 NPI number — 1ST RESPOND MEDICAL SUPPLY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700108636 NPI number — 1ST RESPOND MEDICAL SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1ST RESPOND MEDICAL SUPPLY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700108636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 BUSINESS PKWY
Provider Second Line Business Mailing Address:
STE. 120
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75081-5069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-913-4310
Provider Business Mailing Address Fax Number:
888-310-8034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 BUSINESS PKWY
Provider Second Line Business Practice Location Address:
STE. 120
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75081-5069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-913-4310
Provider Business Practice Location Address Fax Number:
888-310-8034
Provider Enumeration Date:
02/19/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOHIUDDIN
Authorized Official First Name:
AHMED
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
972-913-4310

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1000255 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 217993904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".